*1.Name.(Required.)

*2.Email Address:(Required.)

3.If Get Cycling came to Ripon and the surrounding areas would you, or someone you know, be interested in finding out more about the planned activities?

Yes

No

Maybe

4.To help understand who might be interested we need to know some things about the person/people who are interested. Firstly what is/are the ages of those interested?You can select more than one box if there are more than one person interested.

5- 10 years old

11 - 18 years old

19 - 35 years old

36 - 55 years old

56 - 70 years old

71 - 85 years old

86+ year old

5.What are the specific needs/interests of anyone interested. Please tick all that apply?

Mobility disability

Sensory disability

Cognitive/learning disability

Neurodiversity

Getting older

Social isolation

Loss of confidence

Looking for things to do with a family member who might find cycling difficult.

Other

Other (please specify)